Neurosis

Heavy metal band

For the Record…

Selected discography

Sources

Throughout the late 1980s, heavy metal bands owned the pop music charts. From Poison and Bon Jovi to Ratt and Ozzy Osbourne, music fans wrapped themselves in the reverb of electric guitars. However, by the early 1990s, a new style of music from the Pacific Northwest called grunge—led by Nirvana, Pearl Jam, and others—tossed metal into the scrap pile. Most heavy metal acts, unable to adapt to this change, disbanded. But Neurosis found a way to survive by “developing a style that blended industrial, heavy metal, and alternative rock with often spiritually focused lyrics,” according to Steve Huey of All Music Guide, in comments available at the CDNOW website. The attention focused by the public on grunge did little to thwart Neurosis’ mission for taking chances. However, exploring new sounds was nothing new for the band; in fact, with each subsequent album since their debut in 1987, Neurosis has been evolving and maturing. By adapting to the ever-changing styles of music, Neurosis is “a shining example,” stated Guitar Player, “of what traditional metal can become when it takes the road less traveled.”

Neurosis began its trip down the road less traveled in 1986. Formed in Oakland, California, by vocalist/guitarist Scott Kelly, bassist Dave Edwardson, and drummer Jason Roeder, Neurosis released their debut album, Pain of Mind, as a trio in 1987. Issued on the independent Alchemy label, Pain of Mind, as stated in an AOL online biography, was “discontented hardcore fury.,” In 1990, with the addition of vocalist and guitarist Steve Von Till, Neurosis released The Word as Law. With this album, according to the group’s website, Neurosis “began to experiment with constructing music of varied textures.,” The band’s second release marked other artistic changes. With the release of their second effort, Neurosis began incorporating visual elements into their act, building a devoted underground following.

In 1992, Neurosis continued down a more familiar path by signing with San Francisco’s legendary Alternative Tentacles label to release their next two albums: Souls at Zero and Enemy of the Sun. Souls at Zero with its “mammoth sound,” as Reflex reviewed, “challenge[d] the boundaries of the recording studio and their own minds.,” Yet, according to their website, Neurosis not only wanted to challenge themselves, but also their listeners “who dare listen to tap into the undeniable strength that they emanate—to act on the depravity that surrounds them, and join their uncompromising musical vision.,” These two albums also saw Neurosis incorporating more intense percussion into their music.

Neurosis implemented visual imagery, in addition to their musical intensity, to reveal the group’s musical vision—imagery that articulated the band’s suspicions concerning a modern consumerist society. Neurosis believed that music alone failed to fully reveal the band’s outlook. Rather, they needed art and images as supplements to describe their concept. According to Neurosis, as quoted by Yahoo! Music, “The words are just one part, it takes pictures and moving pictures and sound to create the whole.,”

Neurosis’s blend of art, words, and sound has been inspired by a variety of cultures. Unlike many rock bands, Neurosis refused to limit themselves to the influences of Western societies. Guitarist/vocalist Scott Kelly told the online magazine Loop.com, “we’ve been inspired by all the native cultures… the North American Indians, Odinism, and Druidism.,” Yet, Kelly continued, “we’re just really kind of inspired by the idea that all people were sharing the same thoughts without having any sort of mass form of communication back in those times.,”

In 1996, after three years of hard work, Neurosis released Through Silver in Blood, the band’s most recognized work in terms of popular and critical attention. This album, as described in an AOL online biography is “their most prophetic warning,” and “furthers the scope of their vision, and wraps its black wings around the consciousness like a dire warning.,” The album also, as further described by AOL, is a “call to arms for the angry multitudes to either act on the atrocities around them, or

For the Record…

Members include Dave Edwardson, bass; Scott Kelly, vocals, guitar; Jason Roeder, drums; Simon, keyboards; Steve Von Til (joined band 1990), guitar, vocals.

Kelly, Edwardson, and Roeder formed band, 1986; released 1990’s The Word as Law album; signed with Alternative Tentacles, released Souls at Zero, 1992; released Enemy of the Sun, 1993; returned two years later in 1995 with the re-release of Pain of Mind; signed with Relapse Records and released Through Silver in Blood, 1996; released Times of Grace and recorded as an expansion group called Tribes of Neurot, 1999.

Addresses: Record company —Relapse Records, P.O. Box 2060, Upper Darby, PA 19082, (610) 734-1000; email: www.relapse.com. Website —The Official Site of Neurosis and Tribes of Neurot: http://www.neurosis.com.

simply spiral down the waiting coil of futility.,” However, guitarist Scott Kelly pointed out to Guitar Player that the goal for the album was to “create atmosphere with the music… to use all of the instruments to create one massive sound.,” This album led Neurosis down two more roads less traveled: a personal invitation to tour with the legendary metal band Pantera for OZFEST, as well as a professional formation of an experimental band called Tribes of Neurot.

In 1996, Tribes of Neurot released Silver Blood Transmission which was described on their website as “sound-scape-laden [and] experimental.,” Yet, with the success of Through Silver in Blood, why would Neurosis form this side project? “We formed the Tribes of Neurot,” the band explained in a Corridor of Cells interview, “because we realized that the ideas and philosophies that we were dealing with as Neurosis actually require to be expressed in many different ways.,”

Neurosis continued down their less traveled road in 1999 by releasing Times of Grace with producer Steve Albini. With this album, CMJ New Music Magazine praised, “the band has expanded its reach considerably, interspersing the wall of pain with a few genteel ballads….,” CMJ New Music Report offered their take on the album by comparing it to a famous writer: “Times of Grace is a lot like the plot of Edgar Allen Poe’s The Cask of Amontillado. Each epic song is like a brick, laid to erect a tower of sound that wraps itself around its listeners and seals them in, offering no escape.,” Yet, it is not only the sound that seals in listeners, but also the lyrics. The band told an AOL online interviewer, “we have kind of our own mythology or folklore in which we bring our lyrics from.,” The band further commented that the lyrics are “like a pallet of colors in which we draw… [with no] central theme…. Each song kind of speaks for itself.,” Thus, it seems as if Neurosis has no specific message, or as the band told Corridor of Cells, “we try to avoid giving people specific messages… we don’t want to tell people how to experience things… [only] capture the tone and the emotions behind situations.,”

At the beginning of a new millennium, Neurosis, along with other metal-centered groups such as Type O Negative and 16 Volt, has successfully adapted to music’s ever-changing world and saved itself from heavy metal’s scrap pile. Through their aural and visual albums, Neurosis, as stated on their website, “isn’t a music group, it’s a state of mind. A state of frustration. A state of turmoil and confusion. A state of furied aggression. A state of ominous, death tranquility—the portent of storm on the horizon of musical perception.,”

Selected discography

As Neurosis

Pain of Mind, Alchemy/Alternative Tentacles, 1987.

The Word As Law, Lookout!, 1989.

Souls at Zero, Alternative Tentacles, 1992.

Enemy of the Sun, Alternative Tentacles, 1993.

Through Silver in Blood, Relapse, 1996.

Times of Grace, Relapse, 1999.

As Tribes of Neurot

Silver Blood Transmission, Relapse, 1996.

Sources

Periodicals

CMJ New Music Magazine, November, 1999.

CMJ New Music Report, November, 1999.

Guitar Player, March 01, 1997.

Reflex, November 10, 1992

Online

“Neurosis,” America Online, http://www.members.aol.com/_ht_a/earthad43 (November 15, 1999).

CDNOW, http://www.cdnow.com (November 15, 1999).

Loop.com, http://www.loop.com (November 15, 1999).

Official Site of Neurosis and Tribes of Neurot, http://www.neurosis.com (November 15, 1999).

Yahoo! Music Finder, http://www.musicfinder.yahoo.com

(November 15, 1999).

—Ann M. Schwalboski

Neurosis

Classification

The genesis of neurosis

Of the concepts which modern psychology has introduced into current vocabulary and thinking, “neurosis” and its adjectival form “neurotic” are among the most significant. Applied to individual behavior the terms have been used so loosely and so widely that they have become at times synonymous with morbid, perverse, inexplicable, abnormal, compulsive, and uncontrollable. Since neurosis is so common and neurotic behavior patterns are so varied, there is some justification for the overly generalized, although inexact, use of these terms.

The more precise word for the conditions subsumed under neurosis is “psychoneurosis,” a term which is closer in its etymology to the way we presently understand the nature of these conditions. Currently, psychoneurosis (or neurosis) designates any of a number of psychic or mental disorders which are accompanied by no demonstrable structural or organic change but which result in disorganization of personality and mental function. This disorganization, however, must not be so severe as to impair reality testing and the use of language or to lead to extensive primitivization of behavior. These three limiting conditions serve in a rough way to distinguish neurosis from psychosis. Because quantitative assessment of mental functioning is involved, this distinction is not always easy to make. This is particularly true in the so-called “borderline” conditions. [For further discussion of this aspect of the problem, seePsychosis.]

There is a certain irony of history that in both popular and technical usage the shortened form of the word—neurosis—has come to replace the more accurate form—psychoneurosis. Actually, neurosis is the earlier term. It was coined by William Cullen in the late eighteenth century, in keeping with his concepts of pathology. Earlier theories of psychopathology were based on the assumption that disorders of mental functioning were related to disturbances of the circulation of the blood or to noxious elements carried by the blood stream to various parts of the body. Cullen, a pioneer neuropathologist, advanced the idea that a disturbance of the function of the nerves is the basis for neurosis. To this day, however, it has not been possible to substantiate this hypothesis.

A completely different approach to the concept of neurosis was initiated, however unwittingly, by Cullen’s contemporary, the controversial hypnotist Anton Mesmer. Although the supernatural aspects of Mesmer’s animal magnetism were soon dismissed by the scientific community, hypnotism as a method for investigating the mind continued to hold the interest of many physicians. This trend was culminated by the work of Charcot, who used hypnotism to demonstrate that hysterical symptoms were genuine, not simulated. According to Charcot and his pupil Janet, the essential difficulty in neurotic conditions was neurophysiological. For various reasons usually determined by heredity, the nervous energy of the brain was not strong enough to integrate its many functions. Some functions became dissociated and pursued an independent, autonomous course. When these dissociated elements superseded the normal mental organization, they became the symptoms of hysteria. [SeeHypnosis; Hysteria; the biographies ofCharcot; Janet; Mesmer.]

Freud also used neurophysiology as his frame of reference in his early studies of neuroses, which he too pursued by means of hypnosis. Later, he discarded hypnosis and substituted for it the technique of studying the free associations of his subjects under the standard conditions of the psychoanalytic situation. From the data obtained by this method, Freud concluded that neuroses resulted from disturbances of the physiology of the sexual drive, specifically from inadequate or abnormal discharge of sexual energy, which he designated libido.

Classification

Neuroses, Freud wrote, could be grouped into two major categories according to the origins of inadequate discharge of libido. In one group this could be traced to unfavorable sexual practices. This group of neuroses he called the actual neuroses. Excessive masturbation, for example, dissipates the libido, causing listlessness, apathy, weakness, etc.—the clinical picture of psychasthenia. Abstinence and coitus interruptus, on the other hand, lead to an accumulation of libido, to a pentup state. The libido is ultimately discharged abnormally along subcortical pathways, giving rise to apprehensiveness, irritability, tachycardia, perspiration, and breathlessness—the clinical picture of anxiety neurosis. [SeeAnxiety.]

In the second group of neuroses, libidinal discharge is blocked not by physical causes but by psychological ones. Accordingly, Freud called this group the psychoneuroses. In the psychoneuroses, the symptoms represent not somatic but psychological derivatives of the sexual impulse. Because of their primitive and disturbing nature, such impulses are denied access to consciousness and their energy is barred from discharge by a process which is called repression. Under certain conditions, to be discussed below, the energy of the repressed sexual drive partially overcomes the barrier of repression and achieves disguised and distorted expression in the form of symptoms. In contradistinction to the symptoms of actual neuroses, the symptoms of psychoneuroses have a mental content which, like dreams, can be translated into ordinary verbal language once they are properly understood. What determines the nature of a particular psychoneurotic symptom is what happens to the libido. In obsessions, it is displaced from its proper context onto some ordinarily insignificant thought; in phobias, it is projected onto some substitute object, which is then avoided; in hysteria, the sexual energy is converted into abnormal innervations, causing paralyses and sensory disturbances. [SeeObsessive-CompulsiveDisorders; Phobias.]

Using the same nosological principle, that is, the disposition of libido, Freud made a further division of the psychoneuroses, a division which enabled him to incorporate the psychoses into his system of psychopathology. He divided the psychoneuroses into those conditions in which the libido is vested in mental representations of other persons from those in which the libido is vested almost exclusively in representations of the self.

In the first group he observed that the symptoms were substitute expressions of sexual wishes originally directed toward the significant figures of one’s childhood. During treatment of neurotic patients these wishes of childhood are transferred onto the therapist. Accordingly, he called these neuroses transference neuroses. This group includes the more familiar psychoneurotic entities, for example, hysteria, obsessive-compulsive neurosis, and phobia.

The situation is different in case of psychoses. Transferences presumably do not take place, and the libido remains fixed upon the self, as in the very young child. Freud applied the term “narcissism” to all phenomena in which the self is taken as the object of libidinal wishes. He called the psychoses which constitute extreme forms of narcissism narcissistic neuroses.

Further study has indicated that this nosology is not quite satisfactory. The entire concept of the actual neuroses has been challenged. While it is true that there are neurotic conditions which are associated with abnormal sexual practices, it has been difficult to establish that these conditions necessarily result from such practices or that the symptoms are devoid of psychological content. In addition, transferences do take place even in the so-called narcissistic neuroses or psychoses. To be sure, such transferences may be indiscriminate, transient, and volatile, but they often do represent expressions of libidinal wishes toward figures from childhood foisted onto the therapist or other persons. Furthermore, other elements, such as conflicts over aggression, the inadequacy of the ego’s defenses, and a tendency for regressive primitivization of mental functioning, seem to be equally important in the development of psychosis.

Another group of conditions was subsequently added to this nosology, namely, the traumatic neuroses. Here, neurosis occurs when the organism has been exposed to a life-threatening psychological stimulus of such intensity as to overwhelm the mind’s ability to deal with it. As in the case of the actual neuroses, the essential etiological element is the magnitude of the stimulus, and, here too, the symptoms presumably are without significant psychological content.

Although this classification is widely used, it does justice neither to the great variety of clinical forms which the neuroses assume nor to the multiplicity of factors involved in their etiology. Actually it is difficult to classify the neuroses because they are very complex. They are not distinct, circumscribed entities like tuberculosis, diabetes, or other physical diseases. Any attempt to make a close analogy between neurosis and physical disease is bound to break down upon meticulous examination. Neurosis is part of a developmental process. This is true even though many neuroses appear suddenly and acutely. The neurotic process consists of a wide range of responses to the failure of the mind to resolve inner conflicts. These responses may take the form of symptoms, inhibitions, character traits, and repetitive patterns of behavior. All of these may justly be considered neurotic because they have a common etiology and derivation.

In the 1930s Freud revised his theory of the nature and origin of neurosis in keeping with his appreciation of the central position of intrapsychic conflict in mental life. According to this newer theory, conflict is a regular, normal feature of mental life. The mind can be divided into three groups of functions according to the role each group plays in conflict. One group, the id, consists of instinctual drives—sex and aggression and their derivative manifestations. Another group, the superego, is composed of moral demands and selfpunitive tendencies—the products of training and experience. Finally, there is the group of executant functions, the ego, which integrates the conflicting aims of the id and the superego with due regard to the external or “real” world. As the individual develops and learns, his ability to resolve intrapsychic conflict grows. Mental health depends upon the capacity of the ego to effect an acceptable solution of the conflicting claims made upon it.

The genesis of neurosis

Childhood conflicts

In the genesis of neurosis, the vicissitudes of the psychological conflicts of childhood are of critical importance. The most significant conflicts involve the wishes of the Oedipal phase of development (ages 3 to 6). These wishes, uniformly encountered in almost all children in civilized societies, are concretely experienced in the form of fantasies or fantasy-like thinking. These wishes are simple enough: to possess what one desires and to eliminate what stands in the way of gratification. To the immature mind of the child, its wishes in themselves may appear threatening. In addition, the child fears punishment or retaliation for these thoughts. Anxiety, an innate response to an unpleasant state, appears as a warning affect, signaling the threatening emergence into consciousness of some unacceptable wish, together with the danger of retaliation associated with it. If the ego is unable to master anxiety by repressing the emergent drive, an anxiety state of traumatic proportions may follow. To prevent this and to fend off anxiety, other maneuvers have to be instituted. It is at this point in the conflict that the neurotic process of inhibition or symptom formation begins.

The particular form which a neurosis assumes in a child depends upon the specific measures used to ward off anxiety. All children have severe conflicts, and most children develop some kind of childhood neurosis. Usually a childhood neurosis assumes the form of general apprehensiveness, nightmares, phobias, tics, mannerisms, or ritualistic practices. Most of the primary behavior disorders of children represent disguised forms of neurosis from which the element of manifest fear has disappeared. Phobia is probably the most frequent symptom of childhood neurosis. Fears of darkness, burglars, intruders, ghosts, and animals are so common they are often regarded as part of normal development. Tics and ritualistic practices are less common and in general represent somewhat more severe manifestations of childhood neurosis.

The factors which serve to intensify the conflicts of childhood and to diminish the ego’s capacity to resolve them are many. Some of these factors are constitutional or innate, for example, the inherent strength of the drives and, to a considerable extent, the predisposition to anxiety. The contributing etiological factors which to date have been investigated more thoroughly are the developmental and accidental ones. Most prominent among these are overstimulation, seduction, the effects of physical illness, and various traumata. How the child discharges and controls his drive impulses is determined to a very large measure by the behavior of the parents and earliest teachers. Using gratification and frustration—reward and punishment— and serving as models for identification, parents and educators set the patterns for how conflicts may be mastered.

With the passing of the Oedipal phase the intensity of childhood conflicts abates. The conflicts do not, however, disappear altogether, and, invariably, vestiges of the neurotic process may be discerned in the mental life of children during the period of latency (ages 6 to 12). In some instances, elements of the childhood neurosis may persist through the period of latency into adult life. More often, evidence of the persistent effect of the neurotic process may be seen during latency in character traits, work habits, and sublimations. Not all of these are necessarily pathological. [SeePersonality, article onPersonalityDevelopment.]

Adolescence

The conflicts of the childhood period are evoked anew during adolescence as a result both of physiological changes and of the psychological implications of assuming the adult role. Variations of the fantasies which originally served as vehicles to express drive derivatives during childhood become the conscious concomitant of adolescent masturbation. The guilt over masturbation derives less from the physical activity and more from the unconscious wishes which find substitute expression in the masturbation fantasies. During the period of adolescence a second attempt is made to master conflicts arising from childhood wishes. With the successful resolution of these conflicts, the individual finds his adult identity in his sexual role, moral responsibility, and choice of social role and career. Thus, one can see that the transformation of the neurotic process and its failures is an inherent part of the process of civilizing the individual in the broadest sense. [See Adolescence.]

Neurosis in adults

Neurosis develops anew in adults when the balance between the pressure of the drives and the defensive forces of the ego is upset. This balance may be disturbed in many ways. There are three types of situations which account for neurotogenesis in adults:

(1) An individual may be unable to cope with the additional burden which normal development places upon him. The physiological transformation of the drives, the responsibilities of marriage, and the exigent, competitive, and aggressive requirements of maturity may overtax the capacities of the ego, reviving childhood anxieties.

(2) Disappointment, defeat, loss of love, physical illness, and other inevitable consequences of the human condition may lead an individual to turn from current reality to seek gratification in the world of fantasy. In the development of a neurosis the fantasies to which one turns are usually derivatives of the wishes of the Oedipal phase. As these wishes are regressively reactivated, the conflicts and anxieties of childhood are revived and the process of symptom formation is reinstituted.

(3) By a combination of circumstances an individual may find himself in adult life in a situation which corresponds in its essential features to some childhood trauma or some conflict-laden fantasy. Current reality is then misperceived in terms of the childhood conflict, and the individual responds as he did in childhood by forming symptoms.

The central position of childhood conflicts in neurosis is an empirical finding. It demonstrates that fundamentally neurosis is a developmental disturbance. Although the neuroses of adults, without fail, stem from the neurotic conflicts of childhood, the symptoms from which the adult suffers may be entirely different from those which were prominent during his childhood. It is also important to note that the same unconscious conflict may be resolved by the ego in many different ways. Some resolutions represent progressive development, an enrichment in fact of the adult personality. In the same individual, however, pathological transformation of the conflict may give rise to symptoms.

In order to demonstrate the implications of what has just been said the following clinical material, highly condensed and severely simplified, is offered. A woman patient realized during her childhood that she enjoyed being an only child. Observing her playmates, she felt that the presence of a sibling would deprive her of her parents’ love and of food. She wanted no more children to be born to her parents, and in fantasy she imagined destroying potential rivals by devouring them inside her mother’s body. She felt guilty over these wishes and imagined that the unborn siblings would wreak vengeance upon her. She was told that the fetus, developing in the mother’s body, lived like a fish in a special fluid. She developed a fear of going into the ocean and was unable to eat fish of any kind. When she heard that there are worms which live inside people, she became frightened of all worms. This young, unconscious devourer suffered from nightmares in which animals threatened to devour her. During the latency phase she became interested in raising tropical fish and from this activity developed a deep knowledge of ichthyology. When young fish were born she took pains to remove them from the tank to prevent their being devoured by the older fish. She became a teacher who was extremely protective of her pupils, demanding so little of them that one of her supervisors said in criticism that she tended to “feed” the pupils too much. For her part she was aware that she was afraid her students would disapprove of her. As an adult, she still suffered from a fear of worms. In addition, she developed claustrophobia. Whenever she found herself in a confined space she became extremely anxious. Unconsciously, she feared that the occupants of the confined space would turn upon her and destroy her. She avoided marriage because she thought that she would die of some complication of pregnancy. She avoided any kind of food which could serve as a carrier for intestinal parasites.

In this illustration one can observe the transformations of the childhood conflict over wishes to devour and fears of being devoured in retaliation. The fear of worms persisted from childhood into adult life. The childhood animal phobia and fear of the ocean were replaced in the adult neurosis by claustrophobia. The woman had various eating inhibitions throughout life: in childhood an aversion to fish was dominant, and in adult life an inhibition to eating meat was most prominent. The phenomena just cited represent pathological derivatives of the unconscious conflict, namely, neurotic inhibitions and symptoms. However, the woman’s becoming a teacher and her interest in ichthyology, derived from the same conflict, represent subliminations, that is, activities which enriched her life and contributed to adaptation.

It is evident from what has been said that in every individual some remnant of the anxieties of the childhood period will find representation in the mental life of the adult. To a certain extent, therefore, neurotic trends may be found in every person even in the absence of clinically discernible neurosis. Reliable statistics are very hard to come by because the criteria employed for defining the presence of neurosis vary from one observer to another. It has been estimated by different authorities that between 30 and 60 per cent of the complaints which bring patients to the general practitioner are functional, that is, neurotic in nature. Neurosis as a clinical entity becomes significant only when it reaches the point of severity, where it interferes with the individual’s normal functioning and adaptation.

Most symptom neuroses are mixed in nature. They combine into the clinical picture reactions which are typical for several neuroses. A patient does not necessarily have either hysteria or compulsion neurosis. Usually, his illness shows features of both. Furthermore, there are conditions appropriately termed neurosis which are without symptoms. In such persons their “sickness is their soul.” Their history, their very fate, constitutes a record of failure to contain neurotic conflict within the bounds of symptom formation. Repetitive episodes of failure, victimization, self-induced defeat, and bizarre personal liaisons replace symptoms. Very similar are the severely inhibited personalities. By denying themselves many of the usual sources of gratification and success, they appear to be free of anxiety or symptoms.

Neurosis is a commentary on the ubiquity of intrapsychic conflict in civilized life. It is a distortion of the process of development and adaptation that may afflict an individual as he grows up in a community which demands renunciation of primitive antisocial tendencies. Freud felt that the prevalence of neurosis reflects the deep-seated and universal opposition to the need to effect the renunciation which is essential for civilization.

Jacob A. Arlow

[Directly related are the entriesAnxiety; Mental Disorders; Mental Disorders, Treatment Of; Psychosis. Other relevant material may be found inConflict, article onPsychological Aspects; Developmental Psychology; Individual Psychology; Nervous System, article onStructure and Function of the Brain; Psychoanalysis; and in the biographies ofAlexander; Freud; Horney; Klein.]

bibliography

Arlow, Jacob A. 1963 Conflict, Regression and Symptom Formation. International Journal of Psychoanalysis 44:12-22.

Brenner, Charles 1955 An Elementary Textbook of Psychoanalysis. New York: International Universities Press.

Fenichel, Otto 1945 The Psychoanalytic Theory of Neurosis. New York: Norton.

Freud, Anna (1936) 1957 The Ego and the Mechanisms of Defense. New York: International Universities Press. → First published as Das Ich und die Abwehrmechanismen.

Freud, Sigmund (1916-1917)1963 The Standard Edition of the Complete Psychological Works of Sigmund Freud. Volumes 15-16: Introductory Lectures on Psycho-analysis. London: Hogarth; New York: Macmillan.

Freud, Sigmund (1926) 1959 Inhibitions, Symptoms and Anxiety. Volume 20, pages 77-178 in Sigmund Freud, The Standard Edition of the Complete Psychological logical Works of Sigmund Freud. London: Hogarth; New York: Macmillan. → First published as Hemmung, Symptom und Angst.

Hunter, Richard; and Macalpine, Ida (editors) 1963 300 Years of Psychiatry: 1535-1860. New York and London: Oxford Univ. Press.

NEUROSIS

For psychoanalysts, neuroses are mental disorders that have no discernible underlying anatomical causes and whose symptomatology arises from intrapsychic conflict between unconscious fantasies bound up with the Oedipus complex and the defenses that these fantasies arouse. Neuroses may be defined in several ways. From a topographical standpoint, they may be defined in terms of a specific differentiation of the ego. From a dynamic standpoint, they may be defined by the ego's embrace (under the influence of the superego) of the reality principle, to the detriment of the pleasure principle and the id's instinctual demands, and this leads to the emergence of castration anxiety. From an economic standpoint, they may be defined by a prevalent but partly ineffective mobilization of the mechanisms of repression against the id's instinctual demands. Finally, from a developmental (or genetic) standpoint, they may be defined by the achievement of a symbolization of intrapsychic conflicts in accord with the oedipal model. This basic neurotic structure is variously associated, in the adult as in the child, with different sets of symptoms (hysterical, phobic, or obsessional).

Nineteenth-century medicine used the terms neurosis and psychasthenia interchangeably to denote nervous conditions of "functional" origin. It was accepted that the impact of such conditions on the various bodily systems (digestive, cardiopulmonary, urogenital, etc.) was unrelated to any underlying clinical or anatomical factors, and furthermore that there was no major degradation of the subject's relation to reality. This kind of exclusive diagnosis, purely behavioral and "pre-psychoanalytical," was revived in the 1990s by some present-day nosologies, among them the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM -IV) and the tenth edition of the World Health Organization's International Classification of Diseases (ICD -10).

As early as 1894 Freud drew a distinction between two classes of psychopathological phenomena: on the one hand, the so-called "actual" neuroses, which, in accordance with classical medical theories, he related to a sexual dysfunction contemporaneous with the mental condition (frustration in the case of "anxiety neurosis," masturbation in the case of "neurasthenia"), and on the other hand, the psychoneuroses of defense, whose cause, he set out to show, was to be found in an intrapsychic conflict of infantile origin.

Only the psychoneuroses, which for a time Freud called "transference neuroses," correspond to genuine neuroses as Freud definitively described them in 1924: anxiety hysteria (or phobic neurosis), conversion hysteria, and compulsive (or obsessive) neurosis. This clear distinction between the two types of neuroses, though Freud acknowledged that it was sometimes arbitrary, remained essential to his theory. The hypothesis that the origin of the psychoneuroses lies in intrapsychic childhood conflict constitutes, along with dream theory, the theoretical bedrock of psychoanalysis.

The topographical, dynamic, and economic viewpoints, as presented briefly above, have not undergone any serious revision since Freud's work of 1924. A handful of details aside, all psychoanalytic authors would probably concur with the following formulation from "Neurosis and psychosis": "The ego has come into conflict with the id in the service of the super-ego and of reality; and this is the state of affairs in every transference neurosis" (1924b [1923], p. 150). In contrast, the "genetic" or developmental standpoint still continues into the twenty-first century to spark endless controversy.

In his rereading of Freud's case of the "Wolf Man" (1918b [1914]), Jacques Lacan (1988) drew a clear distinction between what he called "foreclosure" (Verwerfung ) and the concept of repression (Verdrängung ). Evoking the feminine position assumed by the subject in the oedipal scenario (a position that prohibits the subject, under the threat of castration, from accepting genital reality), Lacan noted, "The Verwerfung thus cuts off short any manifestation of the symbolic order" (1988, p. 38). For Lacan, this inability to access the symbolic order differentiates psychosis from neurosis, where there is access to the symbolic order. In his terms, neurotics seek, in a more or less elaborate way, "to introduce into the demand whatever the object of their desire is" and, symmetrically, "to satisfy the demand of the Other by conforming their desire to it." Because the "Wolf Man" could not place himself within this oedipal interplay by means of a "deferred" interpretation of the initial scene of seduction, visited upon him at a very early age by his elder sister, he was partially barred from the "chain of signifiers." In contrast, the phobia of "little Hans" (Freud, 1909b) gave him access to the symbolic order and allowed him to structure his infantile neurosis.

From a quite different perspective, Melanie Klein (beginning in 1930) took up Freud's metapsychological hypothesis concerning the death instinct. Theorizing that infantile anxiety was directed not against the libido but against the destructive instincts, she developed the notions of the schizophrenic and depressive positions, which created a need to revise the theory of the neuroses. For Klein (1975), the possibility of arriving at the depressive position by acknowledging the presence of the destructive instincts within the personality enabled the subject to access the triangular relations of the Oedipus complex and hence to neurotically organize a personality capable of tolerating loneliness. Working in the same Kleinian theoretical tradition, Hanna Segal (1957) described the transition from symbolic equation (an inability to distinguish between symbols and the objects symbolized) to authentic symbolization. Later Segal (1991) extended the theory still further by considering the conditions of artistic creation and revisiting Freud's thoughts on sublimation.

Freud proposed the term "narcissistic neurosis" as a designation for manic-depressive psychosis. This suggestion was not adopted by others, but it draws attention to the need to distinguish between manic-depressive psychosis and the other psychoses, in which the nature of the intrapsychic conflict is clearly very different. Jean Bergeret has described as "false neuroses" a number of clinical conditions mentioned by a variety of authors ("failure neurosis," "abandonment neurosis," "character neurosis," "organ neurosis," and so on) and has proposed a more neutral nomenclature ("failure-prone behavior," "anaclitic relationship," and so on). It is true that, in contrast to hysterical neurosis and obsessional-compulsive neurosis, such conditions are not clearly related to the concept of a neurotic structure. Among such false neuroses, the "traumatic" or "war neuroses" occupy a special place in Freud's metapsychology, for they serve as a point of departure in his development of the hypothesis of a death instinct lying "beyond the 'pleasure principle' " (1920g). Finally, it should be noted that the classificationtransference neurosis has come to have a different meaning from what Freud originally assigned to it; it refers to certain phenomena manifesting themselves in the analysand's relationship with the analyst (transference psychosis is also used in this way).

The notion of neurosis is also related, of course, to the ideas of neuroticization and infantile neurosis as mental processes that give access to symbolization. It is in fact such a powerful organizing concept that it has sometimes been taken for an "overall vision of the human being." However, we would do well to remind ourselves of Freud's consistent and deeply negative attitude toward all such overarching visions and the mysticism that invariably accompanies them.

Francis Drossart

See also: Abandonment; Actual; Acutal neurosis/defense neurosis; Amplification (analytical psychology); "Analysis of a Phobia in a Five-year-old Boy (little Hans )"; Basic Neurosis, The—Oral regression and psychic masochism ; Borderline conditions; Character neurosis; Choice of neurosis; "Claims of Psycho-Analysis to Scientific Interest"; Complex (analytical psychology); Conflict; Developmental disorders; "Dostoyevsky and Parricide"; Failure neurosis; Fate neurosis; Flight into illness; Frustration; Future of an Illusion, The ; "Heredity and the Aetiology of the Neuroses"; Hysteria; Indications and contraindications for psychoanalysis for an adult; Infantile amnesia; Infantile neurosis; Inferiority, feeling of (individual psychology); Introductory Lectures on Psychoanalysis ; "Introjection and Transference"; Narcissistic neurosis; Neurasthenia; "Neurasthenia and 'Anxiety Neurosis"'; Neurotica; Neurotic defenses; Nuclear complex; "Splitting of the Ego in the Process of Defence, The"; Obsessional neurosis; Object a ; Perversion; Phobic neurosis; Phylogenetic Fantasy, A: Overview of the Transference Neuroses ; Primal scene; Psychoanalytic nosography; Psychosexual development; Psychotic/neurotic; "Repression"; Self psychology; "Seventeenth-Century Demonological Neurosis, A"; Subject of the unconscious; Symptom-formation; Topography; Transference neurosis; Traumatic neurosis; War neurosis.

Bibliography

Freud, Sigmund. (1894a). The neuro-psychoses of defence. SE, 3: 41-61.

——. (1909b). Analysis of a phobia in a five-year-old boy. SE, 10: 1-149.

——. (1918b [1914]). From the history of an infantile neurosis. SE, 17: 1-122.

——. (1920g). Beyond the pleasure principle. SE, 18: 1-64.

——. (1924b [1923]). Neurosis and psychosis. SE, 19: 147-153.

Klein, Melanie. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-Analysis, 27, 99-110.

——. (1975). On the sense of loneliness. In The writings of Melanie Klein, Vol. 4: Envy and gratitude and other works, 1946-1963. London: Hogarth. (Originally published 1963)

Lacan, Jacques. (1988). Introduction and reply to Jean Hyppolite's presentation of Freud's Verneinung. In The seminar of Jacques Lacan. Book 1: Freud's papers on technique, 1953-1954 (John Forrester, Trans.). New York: W. W. Norton. (Original work published 1954)

Segal, Hanna. (1957). Notes on symbol formation. International Journal of Psycho-Analysis, 38, 391-397.

——. (1988). Introduction to the work of Melanie Klein. London: Karnac Books.

——. (1991). Dreams, phantasy, and art. London: Routledge and the Institute of Psycho-Analysis.

Further Reading

Shapiro, David. (1999). Neurotic styles. New York: Basic.

Neurosis

A term generally used to describe a nonpsychotic mental illness that triggers feelings of distress and anxiety and impairs functioning.

Origins

The word neurosis means "nerve disorder," and was first coined in the late eighteenth century by William Cullen, a Scottish physician. Cullen's concept of neurosis encompassed those nervous disorders and symptoms that do not have a clear organic cause. Sigmund Freud later used the term anxiety neurosis to describe mental illness or distress with extreme anxiety as a defining feature.

There is a difference of opinion over the clinical use of the term neurosis today. It is not generally used as a diagnostic category by American psychologists and psychiatrists any longer, and was removed from the American

Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1980 with the publication of the third edition (it last appeared as a diagnostic category in DSM-II ). Some professionals use the term to describe anxious symptoms and associated behavior, or to describe the range of mental illnesses outside of the psychotic disorders (e.g., schizophrenia , delusional disorder). Others, particularly psychoanalysts (psychiatrists who follow a psychoanalytical model of treatment, as popularized by Freud and Carl Jung ), use the term to describe the internal process itself (called an unconscious conflict) that triggers the anxiety characteristic of the neurosis.

Categories

The neurotic disorders are distinct from psychotic disorders in that the individual with neurotic symptoms has a firm grip on reality, and the psychotic patient does not. There are several major traditional categories of psychological neuroses. These include:

• Anxiety neurosis. Mental illness defined by excessive anxiety and worry, sometimes involving panic attacks and manifesting itself in physical symptoms such as tremor, chest pain, sweating, and nausea.
• Depressive neurosis. A mental illness characterized by a profound feeling of sadness or despair and a lack of interest in things that were once pleasurable.
• Obsessive-compulsive neurosis. The persistent and distressing recurrence of intrusive thoughts or images (obsessions) and repetitive behaviors or mental acts (compulsions).
• Somatization (formerly called hysterical neurosis). The presence of real and significant physical symptoms that cannot be explained by a medical condition, but are instead a manifestation of anxiety or other mental distress.
• Post-traumatic stress disorder (also called war or combat neurosis). Severe stress and functional disability caused by witnessing a traumatic event such as war combat or any other event that involved death or serious injury.
• Compensation neurosis. Not a true neurosis, but a form of malingering, or feigning psychological symptoms for monetary or other personal gain.

Causes

In 1996, a specific human gene and its corresponding alleles (two components of a gene which are responsible for encoding the gene) were linked to neuroticism. The identified gene and its allele pair help to control the amount of serotonin (a central nervous system neuro-transmitter ) released into the body through the production of a protein known as a transporter. This transporter protein, which helps to carry the serotonin across the synaptic space (the gap between nerve cells) to stimulate nerve cells, also assists the cell in reabsorbing the serotonin (a process known as "reuptake").

In the case of the "neurosis gene," one possible version of its corresponding alleles (called s for their short length) was found to produce an insufficient amount of this transporter protein, and the other (named l for long), a significantly large amount. If the amount of transporter protein produced is inadequate, an excessive amount of serotonin must remain in the synaptic gap while the protein "catches up" with reuptake, and the serotonin will continue to stimulate surrounding nerve cells, resulting in neurosis or neurotic symptoms. A corresponding study of 500 patients showed that patients who were assessed as having neurotic personality traits usually possessed the shorter allele pair (or a combination of one short and one long) that produced insufficient transporter protein.

This finding is consistent with a study published the same year that found that women in 37 different countries scored consistently higher on measurements of neuroticism than men. The fact that such high scores were found across a variety of socioeconomic classes and cultures but specific to one gender seems to support a genetic basis for the disorder. However, a 1998 study of over 9,500 United Kingdom residents found that those with a lower standard of living had a higher prevalence of neurotic disorders. It is possible that genetic factors predispose an individual to anxiety and neurosis, and outside factors such as socioeconomic status trigger the symptoms.

Diagnosis

Patients with symptoms of mental illness should undergo a thorough physical examination and detailed patient history to rule out organic causes (such as brain tumor or head injury). If a neurotic disorder is suspected, a psychologist or psychiatrist will usually conduct an interview with the patient and administer clinical assessments (also called scales, inventories, or tests), to evaluate mental status. Tests which may be administered for the diagnosis and assessment of neurosis include the Neuroticism Extraversion and Openness (NEO-R) scale, the Sixteen Personality Factor Questionnaire (16PF), and the Social Maladjustment Schedule.

Treatment

Neurosis should be treated by a counselor, therapist, psychologist, psychiatrist, or other mental healthcare professional. Treatment for a neurotic disorder depends on the presenting symptoms and the level of discomfort they are causing the patient. Modes of treatment are similar to that of other mental disorders, and can include psychotherapy , cognitive-behavioral therapy, creative therapies (e.g., art or music therapy ), psychoactive drugs , and relaxation exercises.

Paula Ford-Martin

Further Reading

Fenichel, Otto M. The Psychoanalytic Theory of Neurosis: 50th Anniversary Edition. New York: W.W. Norton & Son. 1995.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.

Further Information

Anxiety Disorders Association of America (ADAA). 11900 Parklawn Drive, Suite 100, Rockville, MD, USA. 20852, fax: 301-231-7392, 301-231-9350. Email: AnxDis@adaa.org. http://www.adaa.org.

Neurosis

Definition

Description

Resources

Definition

Neurosis is a term generally used to describe a nonpsychotic mental illness which triggers feelings of distress and anxiety and impairs functioning.

Description

Origins

The word neurosis means “nerve disorder,” and was first coined in the late eighteenth century by William Cullen, a Scottish physician. Cullen’s concept of neurosis encompassed those nervous disorders and symptoms that do not have a clear organic cause. Sigmund Freud later used the term anxiety neurosis to describe mental illness or distress with extreme anxiety as a defining feature.

There is a difference of opinion over the clinical use of the term neurosis today. It is not generally used as a diagnostic category by American psychologists and psychiatrists any longer, and was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in 1980 with the publication of the third edition (it last appeared as a diagnostic category in DSM-II). Some professionals use the term to describe anxious symptoms and associated behavior, or to describe the range of mental illnesses outside of the psychotic disorders (such as schizophrenia , delusional disorder ). Others, particularly psychoanalysts (psychiatrists and psychologists

KAREN HORNEY (1885–1952)

The German-born American psychoanalyst Karen Danielsen Horney was a pioneer of neo-Freudianism. She believed that every human being has an innate drive toward self-realization and that neurosis is essentially a process obstructing this healthy development.

Horney focused on the central position of conflict and solutions to conflict in neurosis in Our Inner Conflicts (1945). She saw the neurotic child feeling helpless and isolated in a potentially hostile world, seeking a feeling of safety in compulsive moves toward, against, and away from others. Each of these moves came to constitute comprehensive philosophies of life and patterns of interpersonal relating. The conflict between these opposed moves she called the basic conflict and recognized that it required the individual to resort to means for restoring a sense of inner unity. These means she called the neurotic solutions.

Neurosis and Human Growth (1950) was Horney’s definitive work, in which she placed her concept of healthy development in the foreground. She viewed the real self as the core of the individual, the source of inherent, constructive, evolutionary forces which under favorable circumstances grow and unfold in a dynamic process of self-realization. She presented “a morality of evolution,” in which she viewed as moral all that enhances self-realization and as immoral all that hinders it. The most serious obstacle to healthy growth was the neurotic solution, which she called self-idealization, the attempt to see and to mold oneself into a glorified, idealized, illusory image with strivings for superiority, power, perfection, and vindictive triumph over others. This search for glory inevitably leads the individual to move away from himself (alienation) and against himself (self-hate). “At war with himself,” his suffering increases, his relationships with others are further impaired, and the self-perpetuating neurotic cycle continues.

who follow a psychoanalytical model of treatment, as popularized by Freud and Carl Jung), use the term neurosis to describe the internal process itself (called an unconscious conflict) that triggers the anxiety characteristic.

Categories

The neurotic disorders are distinct from psychotic disorders in that the individual with neurotic symptoms has a firm grip on reality, and the psychotic patient does not. Before their reclassification, there were several major traditional categories of psychological neuroses, including: anxiety neurosis, depressive neurosis, obsessive-compulsive neurosis, somatization, post-traumatic stress disorder, and compensation neurosis—not a true neurosis, but a form of malingering, or feigning psychological symptoms for monetary or other personal gain.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Press, Inc., 2000.

Fenichel, Otto M. The Psychoanalytic Theory of Neurosis: 50th Anniversary Edition. New York: W.W. Norton and Son. 1995.